Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Jul 2013
Comparative StudyThe "bicipital aponeurosis flex test": evaluating the integrity of the bicipital aponeurosis and its implications for treatment of distal biceps tendon ruptures.
One mitigating factor in the accurate diagnosis of complete distal biceps tendon ruptures (DBTR) is the integrity of the bicipital aponeurosis (BA). Current orthopedic literature lacks a descriptive means of evaluating the integrity of the BA in the presence of distal biceps injury. ⋯ Evaluating the integrity of the BA can help to inform evaluation and treatment of DBTR, especially when visible or palpable alterations in biceps contour and proximal tendon migration are absent or equivocal.
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The purpose of this study was to evaluate wear debris in periprosthetic tissues at the time of revision total elbow arthroplasty. Polyethylene, metallic, and bone cement debris were characterized, and the tissue response was quantified. ⋯ We have shown that periprosthetic tissues of total elbow patients who have undergone revision for loosening and osteolysis contain polyethylene, cement, and metal debris. Although the polyethylene particles were of a size and shape that have been previously shown to result in activation of phagocytic cells, osteolysis after total elbow arthroplasty is a multimodal process. Because of the presence of multiple wear particle sources, a cause-and-effect relationship between polyethylene debris and osteolysis cannot be established with certainty.
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Clavicle fractures are common injuries of the shoulder girdle and occasionally result in nonunion or symptomatic malunion. When present, these chronic injuries can result in considerable shoulder dysfunction. A number of surgical techniques have been described for the management of these injuries. Current literature suggests that supplemental bone grafting may not be necessary in all cases but should be considered in the setting of atrophic nonunion. However, optimal treatment is controversial, as discussed in the literature. This article highlights the current treatment options based on the existing literature and describes our preferred techniques. ⋯ Nonunion and malunion of the clavicle remain challenging problems. Reliable bony union and improved shoulder function can be expected with thoughtful surgical planning, appropriate implant choice, and meticulous surgical technique.
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J Shoulder Elbow Surg · Jun 2013
Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities.
With increasing numbers of arthroscopically assisted acromioclavicular (AC) joint stabilization procedures has come an increase in reports of concomitant glenohumeral injuries among AC joint separations. The aim of the present study was to evaluate the prevalence, pattern, and cause of glenohumeral pathologies among a large patient population with acute high-grade AC joint instability. ⋯ This prospective study showed a high prevalence (30%) of concomitant glenohumeral pathologies, of which some indicate additional surgical therapy and could be missed by an isolated open AC repair. Hence, the arthroscopic approach for AC joint stabilization allows for the diagnosis and treatment of associated intra-articular pathologies.
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J Shoulder Elbow Surg · Jun 2013
Comparative StudyDistal-third clavicle fracture fixation: a biomechanical evaluation of fixation.
Approximately 25% of distal clavicle fractures are unstable. Unstable patterns have longer times to union and higher nonunion rates. Stable restoration of the distal clavicle is important in decreasing the nonunion rate in distal clavicle fractures. The purpose of this study was to biomechanically compare operative constructs for the treatment of unstable, comminuted distal-third clavicle fractures in a cadaveric model using a locking plate and coracoclavicular reconstruction. We hypothesized that the combination of coracoclavicular reconstruction and a distal clavicle locking plate is biomechanically superior to either construct used individually. ⋯ Greater fracture stability was achieved with the combination of the AC TightRope and locking clavicle plate construct than with either alone, suggesting a possibility for increased fracture-healing rates.